Information Collection

Notice of Failure to Make Required Contributions

IC 13574 under ICR 200911-1212-001 · OMB 1212-0041.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1212-0041 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 200 Notice of Failure to Make Required Contributions Notice of Failure to Make Required Contributions	Form
Form 200 Instructions_Proposed Rule_to OMB 11_09.pdf	Instruction
200 Notice of Failure to Make Required Contributions Form 200_Proposed Rule_to OMB 11_09.pdf	Form

IC Title:

Notice of Failure to Make Required Contributions

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Mandatory

CFR Citation: 29 CFR 4043

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Instruction					Yes	Yes	Paper Only
Form	200				Yes	Yes	Paper Only

Line of Business: Income Security

Subfunction: General Retirement and Disability

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 200

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 5 %

table that charts list of burden
	Requested	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	720	294	426
Annual IC Time Burden (Hours)	7,600	6,727	873
Annual IC Cost Burden (Dollars)	2,660,000	2,354,450	305,550

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
No associated records found

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.

Something went wrong when downloading this file. If you have any questions, please send an email to [email protected].